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    Neurogenic Bladder

    Neurogenic bladder is a dysfunction of the urinary bladder due to a neurologic injury.

    This disorder is the consequence of the following process: endocrine.

    Presentation

    Signs and symptoms of neurogenic bladder depends on the nature and the cause of the urinary in continence. These are conveniently divided into two kinds: (A) Symptoms of an overactive bladder which includes urinary frequency, incomplete emptying of bladder, and the progressive loss of bladder control; and, (B) Symptoms of an underactive bladder which include uncontrolled leaks (incontinence), the inability to know if the bladder is full, problems in initiating micturition, and urinary retention.

    Skin
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  • urogenital
    Urinary Incontinence
    • Types of Urinary Incontinence Urinary Incontinence Diagnosis Urinary Incontinence Treatments Urinary Incontinence in Children[news-medical.net]
    • With neurogenic bladder, patients experience either: Overactive bladder - Patients have little or no control urinating, resulting in urinary incontinence and urine leakage.[womenshealth.chesapeakeurology.com]
    • Our urologists cover a broad spectrum of bladder conditions including neurogenic bladder, bladder calculus , bladder cancer and urinary incontinence .[mdmercy.com]
    • A variety of factors can damage these nerves and cause urinary incontinence.[healthcommunities.com]
    • incontinence and deflated to empty the bladder.[uwmedicine.org]
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  • neurologic
    Ataxia
    • Gajewski Cerebral Palsy, Cerebellar Ataxia, AIDS, Phacomatosis, Neuromuscular Disorders, and Epilepsy Christopher Kobylecki, Ling K.[crcpress.com]
    • In addition to parkinsonlike symptoms, patients often exhibit cerebellar ataxia and autonomic dysfunction.[emedicine.medscape.com]
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  • Entire body system
    Infertility
    • Our multidisciplinary team includes specialists in voiding dysfunction, sexual medicine, infertility, men's health, urogenital reconstruction, urinary stone disease, and general and pediatric urology who are dedicated to treating and preventing disease[health.ucsd.edu]
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  • Workup

    In the work-up and management of neurogenic bladder, the following diagnostic modalities are used:

    • Ultrasound of the kidney determines sign of obstruction and enlargement (hydronephrosis)
    • Serum creatinine determination will show the extent of kidney damage
    • Post void residual volume determination will predict the amount of urine retained in the bladder
    • Cystoscopy is the direct examination of the bladder using a flexible cystoscope via the urethra
    • Cytometrography will demonstrate the pressure involved in the bladder

    Laboratory

    Serum
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  • Treatment

    Medical management of neurogenic bladder includes the oral intake of bladder relaxants like oxybutynin, and tolterodine for the treatment of a spastic bladder. Botulinum toxins may be used with local infiltration to the bladder to reduce its spasticity [5]. Hyperactive bladders posing with limit urine capacity may benefit from bladder augmentation surgery [6].

    Patients with difficulty initiating and sustaining urination may benefit with an indwelling catheter or an intermittent straight catheterization for easier voiding. A urinary bladder “pacemaker” may be implanted to automatically stimulate its nerves for functionality purposes.

    The surgical repair of the sphincter and the sling muscle will improve incontinence issues. For permanent voiding access, a stoma (cystostomy) may be created from the abdomen to the bladder for better and hygienic voiding options. Some variant of cystostomy may have an ileal conduit for better quality of life in patients [7].

    Prognosis

    Prognosis in neurogenic bladder depends on the level of the nerve damage. The more central (near the brain) the damage the more complications are expected. Brain damage carries a grim outlook because it hampers hormonal control (antidiuretic hormones), regional nervous and muscle control (detrusor muscle, sphincter and the urinary bladder). Surgical methods for neurogenic bladder may give an excellent outlook for the patient.

    Complications

    Hydronephrosis or the hydrostatic enlargement of the kidneys occurs due to the return pressure exerted by the ureters to the kidney when free flow of urine to the bladder is impeded because of a chronic neurogenic bladder condition. Kidney enlargement may lead to renal failure if left untreated and can eventually lead to death. Recurrent urinary tract infections (UTI) may be experienced with vesico-urethral reflux because of sphincter hyperactivity with neurogenic bladders. The most common pathogen in UTI among neurogenic bladder patients are Escherichia coli, Entrococcus and Pseudomonas aeruginosa [2]. The recurrent urinary tract infection is caused by the persistent stasis of urine in the bladder [3].

    The constant urine leakage may cause pressure or bed sores to dependent parts of the skin especially in the back and in the buttocks. Patients with multiple sclerosis succumbs to the incontinent type of neurogenic bladder which are also associated with uterine prolapse among female patients [4].

    Complications

    Cauda Equina Syndrome
    • equina syndrome 2016 2017 2018 Billable/Specific Code Applicable To Neurogenic bladder due to cauda equina syndrome Type 1 Excludes cord bladder NOS ( G95.89 ) neurogenic bladder NOS ( N31.9 ) ICD-10-CM Diagnosis Code G95.8 Other specified diseases of[icd10data.com]
    • Cauda Equina Syndrome (CES) occurs when the spinal nerve roots in the lower back are compressed.[spineuniverse.com]
    • In a large cohort study, the mean age of neurogenic bladder patients was 62.5 years and resultant aetiologies included 4 : multiple sclerosis : 17% Parkinson disease : 15% cauda equina syndrome : 9% paralytic syndrome : 8% stroke complications: 6% Depending[radiopaedia.org]
    • The acute cauda equina syndrome is often an emergency requiring urgent imaging and surgery.[medlink.com]
    Vitamin B12 Deficiency
    • It may also be caused by brain tumors and other diseases of the brain , pregnancy and by peripheral nerve diseases such as diabetes, alcoholism, and vitamin B12 deficiency.[en.wikipedia.org]
    • Disorders or conditions that cause neurogenic bladder include: Alzheimer’s Disease Cerebral palsy Stroke Spinal cord injury Encephalitis Multiple sclerosis Brain and spinal cord tumors Nerve damage Vitamin B12 deficiency What Symptoms Are Associated with[madisonavenuephysicians.com]
    • These can include: Nerve damage (neuropathy) Nerve damage due to long-term, heavy alcohol use Nerve damage due to long-term diabetes Vitamin B12 deficiency Nerve damage from syphilis Nerve damage due to pelvic surgery Nerve damage from a herniated disk[ufhealth.org]
    • B12 deficiency Alcohol abuse Diagnosis of neurogenic bladder Initially, your doctor will require information on your medication history and conduct a physical exam which will include your abdomen, prostate and rectum.[diabetes.co.uk]
    Dementia with Lewy Bodies
    • Overview Bladder dysfunction is often a disabling manifestation of a variety of brain disorders, such as normal pressure hydrocephalus , dementia with Lewy bodies , vascular dementia , and frontotemporal dementia .[medlink.com]
    Uninhibited Neurogenic Bladder
    • […] neurogenic bladders, including the Lapides classification which remains popular. sensory neurogenic bladder: posterior columns of the spinal cord or afferent tracts leading from the bladder motor paralytic bladder: damage to motor neurons of the bladder uninhibited[radiopaedia.org]
    • A patient with an uninhibited neurogenic bladder will experience sensation but lack voluntary control, so they may have urgency, frequent bladder contractions, and nocturia.[ausmed.com]
    Syringomyelia
    • It is often associated with spinal cord diseases (such as syringomyelia /hydromyelia), injuries (like herniated disks), and neural tube defects including spina bifida .[en.wikipedia.org]
    • Kellett Syringomyelia and Lower Urinary Tract Dysfunction Marc Le Fort, Jean-Jacques Labat, and Brigitte Perrouin-Verbe EVALUATION OF NEUROGENIC BLADDER DYSFUNCTION Clinical Evaluation: History and Physical Examination Chasta Bacsu and Gary E.[crcpress.com]
    Myasthenia Gravis
    • Urinary retention, bowel obstruction, ulcerative colitis, myasthenia gravis, and severe heart disease are contraindications for anticholinergic use.[emedicine.medscape.com]
    Shock
    • Stroke After a stroke, the brain may enter into a temporary acute cerebral shock phase.[emedicine.medscape.com]
    • Soler Pathophysiology of Autonomic Dysreflexia Teresa Danforth and David Ginsberg Pathophysiology of Spinal Shock Magdy Hassouna, Tarek Hassouna, Nader Elmayergi, and Mazen Abdelhady NEUROLOGIC PATHOLOGIES RESPONSIBLE FOR THE DEVELOPMENT OF THE NEUROGENIC[crcpress.com]
    Benign Prostatic Hyperplasia
    • In patients with lower urinary tract symptoms due to benign prostate hyperplasia, sonographic measurement of bladder wall thickness has been demonstrated to be able to replace urodynamic testing for the diagnosis of infravesical obstruction.[clinicaltrials.gov]
    • Bladder outlet obstruction (eg, due to benign prostatic hyperplasia, prostate cancer, fecal impaction, or urethral strictures) often coexists and may exacerbate symptoms.[merckmanuals.com]
    • Haynes Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms in Men with Neurogenic Bladder Jeffrey Thavaseelan and Akhlil Hamid SEXUAL DYSFUNCTION IN NEUROLOGIC DISORDERS Pathophysiology of Male Sexual Dysfunction After Spinal Cord Injury Pierre[crcpress.com]
    Poliomyelitis
    • , not elsewhere classified Approximate Synonyms Detrusor instability Detrusor instability of bladder Functional disorder of bladder Neurogenic bladder Neurogenic bladder as late effect of cerebrovascular accident Neurogenic bladder as late effect of poliomyelitis[icd10data.com]
    • Other diseases resulting in this condition are poliomyelitis, Guillain-Barré syndrome, severe genitoanal herpes infection, pernicious anemia, and neurosyphilis (tabes dorsalis).[emedicine.medscape.com]
    Vitamin A Deficiency
    • It may also be caused by brain tumors and other diseases of the brain , pregnancy and by peripheral nerve diseases such as diabetes, alcoholism, and vitamin B12 deficiency.[en.wikipedia.org]
    • Disorders or conditions that cause neurogenic bladder include: Alzheimer’s Disease Cerebral palsy Stroke Spinal cord injury Encephalitis Multiple sclerosis Brain and spinal cord tumors Nerve damage Vitamin B12 deficiency What Symptoms Are Associated with[madisonavenuephysicians.com]
    • These can include: Nerve damage (neuropathy) Nerve damage due to long-term, heavy alcohol use Nerve damage due to long-term diabetes Vitamin B12 deficiency Nerve damage from syphilis Nerve damage due to pelvic surgery Nerve damage from a herniated disk[ufhealth.org]
    • B12 deficiency Alcohol abuse Diagnosis of neurogenic bladder Initially, your doctor will require information on your medication history and conduct a physical exam which will include your abdomen, prostate and rectum.[diabetes.co.uk]

    Etiology

    Any disorder in the central nervous system that affects the brain and the lower body may lead to neurogenic bladder. The following etiology has been noted to amongst the most common:

    Causes

    Epidemiology

    The incidence of neurogenic bladder is variably dependent on the individual incidences of the primary disease or pathology that gave rise to them. In patients diagnosed with multiple sclerosis, the incidence of neurogenic bladder reaches 20 to 30% within 10 years from diagnosis but for those with detrusor muscle paralysis, 30 to 50% will present in incontinent type of paralysis.

    Scientific data have shown that the incidence of neurogenic bladder in Idiopathic Parkinson’s disease (IPD) is 57% to 83% which manifests as incontinence, urgency and frequency symptoms. In traumatic spinal cord injuries, patients will present with some of bladder dysfunction within the year of the trauma in approximately 81% of cases.

    Young adults suffering from spina bifida will show signs of urinary incontinence in up to 61% of cases. The incidence of neurogenic bladder in these cases are dependent on the anatomic location of the lesion and the extent of nerve damage.

    Sex distribution
    Age distribution

    Pathophysiology

    Neurogenic bladder may occur when the central nervous system sustains damage in the level of the brain, pons, sacral cord and the peripheral nerves. Nerve damage will lead to dysfunctional voiding condition ranging from mild urinary retention to an overactive bladder (OAB).

    Urinary incontinence happens when the bladder and sphincters dysfunction. Urge incontinence occurs with a spastic bladder or an overactive one. Uncontrolled voiding with stress incontinence manifests when neurogenic sphincter control and the detrusor muscle is compromised.

    Prevention

    Neurogenic bladder may be prevented only by preventing the primary medical and surgical conditions that cause it. For patients diagnosed with multiple sclerosis, the 10 year interval before signs of neurogenic bladder starts will give enough time for them to do pelvic floor strengthening exercises (Kergel exercises) to improve incontinent problems. Children with neurogenic bladder may be allayed by regular nocturnal emptying of urine to prevent leaks and incontinence [8].

    Patients who have undergone abdominal surgery or those with recent trauma should do early ambulation and exercises to prevent neurogenic bladder from ensuing. Neurogenic bladder with increased risk for recurrent UTI has been found to benefit from bladder inoculation with Escherichia coli antigen which lowers the incidence of UTI episodes per year [9]. Studies have revealed that the regular intake of cranberries tablet has been demonstrated to reduce incidence of UTI in a third of all compliant subjects [10].

    Summary

    Neurogenic bladder is a clinical disorder characterized by a dysfunction in the urinary bladder due to a neurologic injury. The urinary bladder is a muscular structure in the hypogastrium that controls the storage and excretion of urine.

    The coordinated muscle movement including sphincter control is compromised in the urinary bladder in this disease condition. Neurogenic bladder may present as a progressive loss of bladder control (urinary incontinence) on the release of urine, inability to voluntarily release urine, and urinary frequency. There are cases of congenital neurogenic bladder in infants born with a spinal cord defect (spina bifida) or spinal cord injury.

    Patient Information

    Neurogenic bladder must be viewed as a complication of a primary disease thus any damage to the nerves (spinal) must be brought to medical attention for the proper diagnosis of impending nerve damage. Those diagnosed with neurogenic bladder must learn to identify signs of early urinary tract infection for prompt treatment and averting complications. Catheter and stoma care should always remain sterile to prevent secondary infections.

    Other symptoms

    Neurogenic Bladder
    Vesicoureteric Reflux
    • reflux) Innovative Neuro-urology Care We draw referrals from all parts of Texas, Kansas, Arkansas, Louisiana, Colorado, New Mexico, and the East and West Coasts.[utswmedicine.org]
    • Risk of serious complications (eg, recurrent infection, vesicoureteral reflux, autonomic dysreflexia) is high.[merckmanuals.com]
    • reflux (abnormal urine back-up) Diagnosis: In the case of neurogenic bladder, a patient's nervous system and bladder are tested to determine a diagnosis.[tucc.com]
    • "[Treatment of vesicoureteric reflux and neurogenic bladder]".[en.wikipedia.org]
    • As a result, these children are followed very closely with renal bladder ultrasounds, VCUG tests (which can detect bladder abnormalities or vesicoureteral reflux), and DMSA tests to look for renal damage.[rchsd.org]
    Bethanechol
    • Additionally, a muscarinic agonist like Bethanechol may also be used, particularly in the postpartum or postoperative period.[en.wikipedia.org]
    • Bethanechol – This medicine can help keep your nerves active so that you keep control of the muscles around your bladder.[mainlinehealth.org]
    • Your health care provider may suggest: Medicines that relax the bladder (oxybutynin, tolterodine, or propantheline) Medicines that make certain nerves more active (bethanechol) Botulinum toxin GABA supplements Anti-epileptic drugs Your provider may refer[ufhealth.org]
    • Bethanechol is the most commonly prescribed drug to help stimulate bladder contractions in patients who retain urine.[healthcentral.com]
    Herniated Disc
    • disc or stenosis of the spinal canal General neuropathy Long-term, heavy alcohol use Some pelvic surgeries Tumors of the central nervous system Vitamin B12 deficiency.[denverurology.com]
    • Typical causes are a sacral cord tumor, herniated disc, and injuries that crush the pelvis.[emedicine.medscape.com]
    Neural Tube Defect
    • It is often associated with spinal cord diseases (such as syringomyelia /hydromyelia), injuries (like herniated disks), and neural tube defects including spina bifida .[en.wikipedia.org]
    • Tube Defects: Etiology, Prevention, and Prenatal Diagnosis Atsuo Kondo, Shinji Katsuragi, and Osamu Kamihira Initial Management of Meningomyelocele Children Stuart B.[crcpress.com]
    Teratoma
    • It is a common complication of major surgery in the pelvis, such as for removal of sacrococcygeal teratoma and other tumors.[en.wikipedia.org]
    Peripheral Nervous System Involvement
    • Historical note and terminology Neurogenic bladder is a dysfunction of the lower urinary tract due to diseases of the central nervous system or peripheral nervous system involved in the control of micturition.[medlink.com]

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    References

    1. Beuerle JR, Barrueto F. Neurogenic bladder and chronic urinary retention associated with MDMA abuse. J Med Toxicol. 2008; 4(2):106-8 
    2. Romero-Cullerés G, Planells-Romeo I, Martinez de Salazar-Muñoz P, Conejero-Sugrañes J. Urinary infection in patients with neurogenic bladder: patterns of resistance to the most frequent uropathogens. Actas Urol Esp. 2012; 36(8):474-81 
    3. Balsara ZR, Ross SS, Dolber PC, Wiener JS, Tang Y, Seed PC. Enhanced susceptibility to urinary tract infection in the spinal cord-injured host with neurogenic bladder. Infect Immun. 2013; 81(8):3018-26 
    4. Dillon BE, Seideman CA, Lee D, Greenberg B, Frohman EM, Lemack GE. A surprisingly low prevalence of demonstrable stress urinary incontinence and pelvic organ prolapse in women with multiple sclerosis followed at a tertiary neurogenic bladder clinic. J Urol. 2013; 189(3):976-9
    5. Kanai A, Zabbarova I, Oefelein M, Radziszewski P, Ikeda Y, Andersson KE. Mechanisms of action of botulinum neurotoxins, β3-adrenergic receptor agonists, and PDE5 inhibitors in modulating detrusor function in overactive bladders: ICI-RS 2011.Neurourol Urodyn. 2012; 31(3):300-8 
    6. Stein R, Schröder A, Thüroff JW. Bladder augmentation and urinary diversion in patients with neurogenic bladder: surgical considerations.J Pediatr Urol. 2012; 8(2):153-61 
    7. Guillotreau J, Castel-Lacanal E, Roumiguié M, Bordier B, Doumerc N, De Boissezon X, Malavaud B, Marque P, Rischmann P. Prospective study of the impact on quality of life of cystectomy with ileal conduit urinary diversion for neurogenic bladder dysfunction. Neurourol Urodyn. 2011; 30(8):1503-6 
    8. Koff SA, Gigax MR, Jayanthi VR. Nocturnal bladder emptying: a simple technique for reversing urinary tract deterioration in children with neurogenic bladder. J Urol. 2005; 174(4 Pt 2):1629-31; discussion 1632 
    9. Darouiche RO, Green BG, Donovan WH, Chen D, Schwartz M, Merritt J, Mendez M, Hull RA. Multicenter randomized controlled trial of bacterial interference for prevention of urinary tract infection in patients with neurogenic bladder.Urology. 2011; 78(2):341-6 
    10. Hess MJ, Hess PE, Sullivan MR, Nee M, Yalla SV. Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder. Spinal Cord. 2008; 46(9):622-6 

    • Augmentation cystoplasty in the management of neurogenic bladder disease and urinary incontinence. - JL Lockhart, D Bejany, VA Politano - The Journal of urology, 1986 - ukpmc.ac.uk
    • Of human overactive bladder following intradetrusor injections of botulinum neurotoxin type A for the treatment of neurogenic or idiopathic detrusor overactivity - A Apostolidis, TS Jacques, A Freeman, V Kalsi - European , 2008 - urosource.com
    • Study of the efficacy and anticholinergic side effects of transdermal compared to immediate release oral oxybutynin treatment of patients with urge urinary incontinence - GW Davila, CA Daugherty, SW Sanders - The Journal of urology, 2001 - Elsevier
    • Neurogenic bladder. I. The influence of repeated filling and various filling rates on the cystometrogram of neurological patients with normal and uninhibited neurogenic - D Jensen Jr - Acta neurologica Scandinavica, 1981 - ukpmc.ac.uk


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